E6: The Role of Exercise and Physical Therapy in Scoliosis

Dr. Tony Nalda's practice, Scoliosis Reduction Center, is cutting-edge when it comes to the role of exercise and physical therapy in scoliosis treatment. This made him an excellent co-host for episode 6 of Life Beyond the Curve.

While Dr. Nalda is a chiropractor, not a physical therapist, he has over 20 years of experience working with the biomechanics of the spine, treating patients, and practicing a variety of scoliosis-specific treatment methods.

The innovations he has helped develop in the customized CLEAR home exercise program have helped thousands of scoliosis patients world-wide. Throughout episode 6, Dr. Nalda discusses:

  • Why traditional physical therapy treatment for scoliosis patients falls short.
  • How active and passive rehabilitation in the CLEAR approach to treating scoliosis help stabilize the spine and reduce the curve.
  • Why the custom home exercise program works best when coupled with in-office care and rehabilitation.
  • How he motivates his teenage patients to stay on track with their care.
  • Why timing is everything when it comes to scoliosis treatment.

Don't miss your opportunity to learn more about the role of exercise and physical therapy in scoliosis treatment. Enjoy the show!

CLEAR Blog Articles by Dr. Nalda

The Dr. Tony Nalda Show - A Podcast by Dr. Nalda

Scoliosis Reduction Center Resources

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Episode Transcript

Ashley B (00:01):

Hello, hello, Ashley Brewer here, Executive Director of CLEAR Scoliosis Institute and your host for today's episode of Life Beyond the Curve, where we're committed to providing essential support for people living with scoliosis. When I recorded Episode Six, The Role of Exercise and Physical Therapy in Scoliosis Treatment, I had the opportunity to talk to Dr. Tony Nalda, who happens to be the Chairman of the CLEAR Board of Directors, and he's actually one of only two members of the CLEAR Senior Fellowship program. Now, I couldn't think of a better person to discuss this topic with, because I've actually had the privilege of being a patient of Dr. Nalda's, and I've been in the chiropractic profession for over 11 years. So before visiting Dr. Nalda's clinic as a patient, I'd obviously been a chiropractic patient with other chiropractors. I remember being absolutely blown away by Dr. Nalda's level of expertise.

Ashley B (01:09):

And when we get together to have discussions, like when we recorded this podcast, I'm still blown away by everything that he knows to this day. Not because my previous chiropractors didn't know things, but really because Dr. Nalda is extremely cutting edge when it comes to caring for the spine and spinal correction. He is the lead trainer for ScoliBrace in North America. He is the developer of Max Living's spinal correction program and their trainer to date. And he just has too many other certifications for me to list. So I am going to let the knowledge that he shares speak for itself. Episode Six, here we go!

Intro (01:56):

You're listening to Life Beyond the Curve, a podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show.

Ashley B (02:22):

Good morning, Dr. Tony, welcome to Life Beyond the Curve. I am so glad to have you joining us again. Hello, Ashley. Thanks for having me on today. So Dr. Nalda, today, we're talking about scoliosis exercise and physical therapy, and as a CLEAR-certified chiropractor, you provide patients with a natural and non-invasive approach to treating scoliosis that combines some of the stuff they do in your office and then a home exercise program or rehabilitation program. Um, so I guess my first question for you is actually two questions combined. How does this approach differ from traditional physical therapy and then, two, what would traditional physical therapy look like for a scoliosis patient?

Dr. Nalda (03:13):

Traditional physical therapy, and the CLEAR approach to scoliosis treatment are not the same. And when it comes to traditional physical therapy, let me first off say that I'm not a physical therapist, by no means, I've never been trained in a physical therapy school traditionally, but I have lots of patients that are physical therapists, and I work with a lot of physical therapists that understand that what we do in our CLEAR approach to scoliosis. And what I see and what I've taught is that traditional physical therapy is normally done very similarly to traditional chiropractic, it's that it's done in response to injury. Meaning most physical therapy are designed to treat acute injury problems, to help rehabilitate an injured area, where the problem is scoliosis isn't an injury. Scoliosis is a developmental problem that has been progressing during growth or in adulthood, and it's been there for a very, very long period of time.

Dr. Nalda (04:13):

So traditional physical therapy approaches are not effective in multiple ways. Number one, it's in the way it's performed. Most traditional physical therapy is done very slowly over a long period of time. Meaning a patient will go in once, twice or three times a week for a period of six months or so to try to rehabilitate a injured area, like a knee or shoulder or spine, or for that matter. When it comes to scoliosis, that slow approach has no effect because it's like throwing a ball against the wall, meaning that any improvement that they achieve is quickly lost before their next session, if, if there is any improvement at all. In addition, most traditional physical therapy approaches are done very symmetrically, meaning they're done, um, to help strengthen general stability or general muscles of the body to create stability in those areas and to try to make a body more symmetrical.

Dr. Nalda (05:07):

The problem with scoliosis is that nothing is symmetrical about them. So therefore addressing a scoliosis symmetrically will never lead to a good outcome. Also, the traditional physical therapy is normally done in a stabilizing--only a stabilizing manner, which can obviously have some problems when we deal with scoliosis and the rigidity that's associated with it. So what's the difference in the CLEAR approach? The CLEAR approach talks about taking scoliosis and not only just trying to stabilize it, but physically try to reduce the curve. And the reason why they want to reduce the curve is because anytime you can reduce a scoliosis, exercise becomes easier. So first thing is the approach; we don't do--we try not to do slow rehabilitation over a long time, but we try to do short, intense rehabilitation. This invert model allows us to make a greater impact, as opposed to throwing a ball against the wall, that we can actually build on every session as we go.

Dr. Nalda (06:16):

So as opposed to doing a little bit of therapy, one, two, or three times a week, a patient does a lot of therapy every single day, sometimes four to six hours, to get a very rapid change in the spine. Second thing is that the therapy is typically--the exercises are typically done in combination with therapy and rehab to help make the spine more flexible. This allows exercises to become more effective. And then last thing is that none of the therapy or exercises are done symmetrically. Everything's done asymmetrically to try to deal with what the scoliosis is presenting with that patient. And every single one is catered to the curve that we're actually dealing with.

Ashley B (07:01):

I appreciate you getting into the CLEAR method. Going back a little bit to physical therapy, I understand that there can be some challenges when using physical therapy to treat or manage scoliosis. So let's talk about that for a little bit. When is physical therapy the most effective for a scoliosis patient?

Dr. Nalda (07:25):

So traditionally physical therapy is gonna be most effective for a patient, like I mentioned a little bit earlier, is when their spine isn't rigid. That's the most challenging thing when it comes to treating a scoliosis, is the rigidity it develops as their curve gets larger and larger and larger. So if we don't actually deal with any type of flexibility component, when it comes to increasing flexibility of the spine itself, the physical therapy itself can be very limited. However, in small curves where curves are still very flexible, meaning curves less than 25 degrees, less than 20 degrees, if the patient is given a very specific scoliosis type of therapy and rehab that may be effective in stopping or slowing progression, but it can't be general therapy. It can't just be general rehabilitation for the spine. It needs to be very catered to that specific scoliosis and to what that patient can do.

Ashley B (08:19):

So earlier you went into a little bit about the difference between the CLEAR approach and physical therapy, but let's dig a little bit deeper into that topic.

Dr. Nalda (08:31):

So I went over, what are the main general differences between the physical therapy approach versus a CLEAR approach, but to be more specific is that number one is that the CLEAR approach is that we break down exercises into multiple versions of exercise. First thing we use is something called isometric exercises. I assume that your exercises are done in sectional areas of the spine, cervical, thoracic, or lumbar areas. And these are done in the region to help strengthen asymmetrically different muscles of the spine that needs strengthening, not just because they're weak, but more importantly, to help realign the spine and use the muscles as movers of the spine to help the spine function better. In addition to the isometric exercises that we give each and every patient that's catered to their scoliosis, we do something called neuromuscular re-education. Neuromuscular re-education is like a reflexive exercise, meaning that we're using body weights and therapies to help the body react into a better position.

Dr. Nalda (09:37):

This reactive exercises connects to brain-body or the brain-muscle connection stronger than an isometric exercise we can do. The neuromuscular re-education's a very powerful component in the CLEAR program. And then in addition, many CLEAR doctors also use something called a self-correction exercise. Self-correction exercise is where we teach a patient how to actually correct their scoliosis using their own muscles. And they use mirrors as feedback to help do a self correction. And then once you're taught how to correct their spine, then they're taught specific exercises to perform while they're in a corrected position. The combination of this isometric, this neuromuscular re-education, and the self-corrective exercises allow us to develop a program that's very strong and customized for each and every patient to provide the very best outcome.

Ashley B (10:32):

Yeah, this customized program that you're talking about is absolutely one of the biggest benefits to the CLEAR approach. And what's unique about it is that it doesn't take the place of in-office care, but it compliments it, giving the patient the best chance at achieving curve correction. Now, patients actually do these exercises prescribed by a CLEAR-certified doctor in the comfort of their own home. Let's talk a little bit more about how this works and how this can actually work to reduce someone's curve.

Dr. Nalda (11:13):

Yeah, Ashley, you are absolutely correct that the home program is critical for, for every patient to help stabilize the curve, but they work in combination with an in-office treatment. And this is an important concept because when typically when patients seek treatment, they'll go to an orthopedist, they'll go to an orthotist, they'll go to a physical therapist, they'll go to an exercise physiologist. They'll go to a massage therapist. They go to a chiropractor. They're seeing all these different doctors and therapists and nobody is working together. And that's one of the main benefits of the CLEAR approach, is that the CLEAR doctor is coordinating the therapy, the rehab, the exercises, the chiropractic care. And in a lot of cases are designing the re--the brace to work with all those therapies and rehabilitations. So there's one doctor coordinating the entire program. So that's the first thing is that everything is adding to the next. Last, in addition is that the in-office therapy is designed to accentuate the home program.

Dr. Nalda (12:15):

So the goal of the office therapy is to develop the most effective program that's going to work at home, based upon the results that are delivered in the in-office program. So the in-office program is more successful because of the development of the home program during that process, because we can see what responds and what doesn't respond. So therefore, when the person goes home with the home program, we already know what it's going to do because we tested it and developed it in the in-office program. So this combination actually work together to actually reduce the scoliosis. The combination of these two things are very, very effective. Lastly is one of the main limitations is flexibility of the spine. The in-office program allows us to increase flexibility of the spine, so now that every exercise they perform is more flexible. For example, if you wanted to work out your bicep muscle, but you couldn't move your elbow, there's only so many exercises you can do.

Dr. Nalda (13:19):

However, if we can increase your range of motion of your elbow, so you can work your bicep muscle better, you're going to have a greater variety in a greater effectiveness of exercises that you can perform for that muscle. So that in-office therapy actually helps the home therapy work better. So like you said, they work very, very closely together. And so therefore developing a home therapy program without somebody going through office therapy first would be almost impossible. I couldn't even imagine trying to come up with a home rehabilitation program without seeing how somebody responds to our in-office therapy first, so we can know whether it's going to be effective or not.

Ashley B (14:01):

Now I've been in your office multiple times, and I know that you see patients of every single age, you've got babies in your clinic, uh, elderly individuals in your clinic. Let's just stop for a second and talk about the teenagers that you see. I'm a mom and I have a daughter who is 13, almost 14, and so I know firsthand that teens can be super challenging to say the least. When it comes to this home exercise program, what do you find most often motivates the teenagers to actually spend time doing their exercises, and how much time do they have to spend throughout the day doing these? Because as a mom, I can see how that may be hard to get my daughter to do something like that.

Dr. Nalda (14:55):

You know, in, in every teenager, motivation to anything can sometimes be difficult. But what I find is what is the most motivating thing for kids is number one is they know the truth. They know the truth about scoliosis and what it potentially can become. Kids these days are very acute to what's going on. And they're way more educated than I ever was at 13 or 12 years of age. So therefore, if they understand what scoliosis is, what the impact it can have over their life if it's left uncorrected and what the implications of surgery are, they can become very motivated to do something. And normally with these patients, if they're just motivated for about three months, they start seeing the drastic improvement in their bodies and their posture and their x-rays. And that's the most motivating thing is when patients can start seeing responses, especially kids, the positive response is the most motivating thing. What's most, most frustrating for these kids is that they go in and they get diagnosed and they told to come back in six months later, the curve gets worse.

Dr. Nalda (16:03):

So now they said, okay, let's wear a Boston brace. They go wear the Boston brace, they wear it like they're supposed to, they come back six months later and the curve is worse. And now they said, okay, well now wear the brace full time, they wear it full time, they come back in six months and their curve is worse. So every time they get--every time they do something, their curve just gets worse and worse and worse until they're told they need surgery. When they start getting a positive response and they're seeing, okay, they go home and it's do your therapy, do your rehab, do your exercises, wear your brace, you come back three months later and the curve is better and their posture is better and they can see it, they're like, wow, this is actually working! Now it's really, really easy to motivate kids because most all of these kids want to see themselves get better, especially posturally.

Dr. Nalda (16:43):

So seeing posture changes and seeing positive changes and them understanding what the reality of what scoliosis is, can be the most motivating things for kids. And then last thing is, of course, is seeing some pre and post x-rays, seeing the possibility, you know, we can show pre and post x-rays and pre and post posture pictures of almost any type of curve type. And when we can show them that, and they can see that this is what this other teenager did, they were able to do it, they were able to reduce their curve, able to reduce the curve below surgical levels, not only that, but reduced their curve and get their posture better and never have a rod put in their spine? That becomes very motivating. So I'm not going to say I don't have challenges with patients. We do. I mean, very recently I had a patient that we started with care, you know, in the low forties.

Dr. Nalda (17:29):

And we were able to reduce their curve to about the thirties with the intensive program, went home, did home therapy. And unfortunately didn't follow through and was doing about half of what I--we expected. Now, even though this is not the best result, they ended up going back to their exact curvature when they first started within, within about six months. But the truth is the person grew during that phase. So they grew, if they did nothing, they would have gone from where they started a 43 to probably 50 or 53. They only went back to where there was. And now this, he understood, Hey, I actually have to do my home treatment. So we, we implemented the treatment. He committed for 90 days, 90 days later, he saw some postural change. And now this boy's doing great with their home therapy. Typically, if they can stick on the program for 90 days, they're going to get the response, enough positive feedback that they're going to want to continue.

Dr. Nalda (18:22):

In addition, our home program, isn't super strenuous, meaning that they're not, it doesn't take three, four or five hours a day to perform therapy, like some Schroth exercises. If you guys ever heard about the Schroth program, it can be very difficult for kids to do. So our exercise program tends to be twice per day. Typically the exercise rehabilitation can be less than 30--it can be 30 minutes or less sometimes. So it's twice per day, maybe 60 minutes at top amount. Sometimes it can be sometimes 40 minutes depending on the size of the curve. And normally it's done, you know, when they get home from school and before bed, and it's a, normally some of the, some of this stuff can be done passively, meaning they're just going to be laying on something or doing something while they can actively do something else, like watch TV or look at their phone or look at the computer or do something along those lines. So they can kind of, time goes by quickly. There's only a very handful of exercises they have to really, really focus on only that and do nothing else, but the majority of stuff can be done, you know, while they're doing something else, which doesn't make it too bad for them.

Ashley B (19:27):

Doctor Nalda, it's so great to hear that you are able to find ways to motivate even the teenagers in your office. Um, motivation and inspiration are two of the reasons why we actually started this show. So the goal behind Life Beyond the Curve is to provide people living with scoliosis or, or their family members, with tangible action steps that they can begin implementing almost immediately to positively impact their life and their confidence. And I know that confidence is a big thing for teens as well. So all those things considered, if you had one piece of advice for someone surrounding the topic of scoliosis exercise and physical therapy, what would that be?

Dr. Nalda (20:18):

The biggest thing I can talk about when it comes to exercises and therapy and scoliosis is don't dabble. The be--wasting time doing an exercise program that's been kind of created by many, many, many different doctors, and you're kind of piecemealing your own program and you're dabbling and all this stuff is more likely not going to produce the result you want. The best thing for you to do is to look at a program that's developed for you by somebody who understands your curve, who specializes in scoliosis, so you can make sure you're being most effective with your time and getting the very best possible rehabilitation therapeutic program that you could possibly get. In fact, if you're doing this for a child that's growing, your time wasted in dabbling or trying to put together your own program could be the very time that the curve progresses now to become surgical. And now we're dealing with a whole other curve. So making the choices, the right choices at the right time will give us the very best response.

Ashley B (21:20):

So it sounds like timing is everything. Uh, thank you so much for joining us today, Dr. Nalda, I definitely look forward to our next conversation and our next episode of Life Beyond the Curve. Now, if you are listening and you would like more information on scoliosis, visit clear-institute.org, where you will find additional podcasts, articles, blog posts, and much more information that will help you navigate your scoliosis diagnosis. Again, that's clear-institute.org. There is more to come next week. We will talk to you soon.

Author: Dr. Tony Nalda

After receiving an undergraduate degree in psychology and his Doctorate of Chiropractic from Life University, Dr. Nalda settled in Celebration, Florida and proceeded to build one of Central Florida’s most successful chiropractic clinics. His experience with patients suffering from scoliosis, and the confusion and frustration they faced, led him to seek a specialty in scoliosis care. In 2006 he completed his Intensive Care Certification from CLEAR Institute, a leading scoliosis educational and certification center. A leader in chiropractic care, Dr. Nalda has led a family practice for 20 years and is an instructor for Core Chiropractic, for MaxLiving doctor support training.
Reach out to Dr. Tony Nalda

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